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Doors Open for Emergency Nurses

The last place people want to land is in the emergency room of a hospital. But for nurses, the emergency room (ER) can be a great place to gain experience and focus on a nursing specialty. Opportunities for nurses with ER experience are wide ranging -- from cardiac care to forensics.

Emergency nurses, also known as trauma nurses, assess and care for patients who enter the emergency department. Patients often have life-threatening conditions including heart attacks, stab wounds or injuries from car accidents.

Bud Eyre is a nurse. He splits his time between the hospital's intensive care unit (ICU) and the emergency room. He says many nurses go from emergency to a specialty area of nursing.

"In emergency, you get experience with everything," he points out. He enjoys the challenge of working in emergency. "You don't know what you'll have day to day -- it's always something different."

Career Paths That Begin in the ER

Gaining varied experience opens doors to many nursing specialties. For example, in emergency, nurses are likely to see a lot of fractures (broken bones). If a nurse is interested in this area, he or she might choose to specialize in orthopedics. This branch of medicine deals with bones, the skeleton and diseases of the body's muscles and bones.

Emergency room workers also see a lot of people with heart attacks. A specialty in cardiac care might suit an interested nurse. Nurses who prefer a lower nurse-to-patient ratio might enter the ICU. When providing intensive care, nurses are typically one-on-one with very critical patients. They see patients who've just come out of operations or have failing health for any number of reasons.

Forensic nursing is another nursing specialty. Georgia Pasqualone had many years of experience as an emergency nurse before she broke out on her own. She's now a forensic nurse consultant, investigator and lecturer in Winchester, Massachusetts.

She says 27 percent of patients who come through emergency are forensic patients. Forensic patients may have traumatic injuries or legal issues related to their emergency visit. For example, victims of assault, abuse and neglect are considered forensic patients. Perpetrators of crimes are also forensic patients.

"The role of the forensic nurse is to provide comprehensive health care to the victim of violence (or offender) while incorporating knowledge about the legal impact or considerations that may be involved," explains Cathy Carter-Snell. She is a forensic nurse and instructor.

Sexual assault nurse examiners are another type of specially trained nurse. These nurses provide care to sexual assault patients, conduct medical forensic examinations and can serve as expert witnesses.

Some emergency nurses become qualified as transport nurses. Transport nurses care for patients while they're being moved by helicopter or airplane to a medical facility.

"There are a lot of choices available when it comes to nursing," says Eyre. "You can find your niche and work hard to excel at it."

Nurses as Advocates

Carter-Snell taught a course in forensic nursing to a memorable ER nurse. After the course, the nurse identified a lack of domestic violence screening among ER patients and began working to raise awareness among ER staff.

She became a driving force behind the development and implementation of two screening questions for all ER patients. Nurses now ask if violence is a part of the patient's life and if so, do they feel safe.

"I love this example because [this nurse] took the courses with the intent to improve her ER practice," says Carter-Snell. "She was able to change her practice, implementing the knowledge into her everyday practice, helping to identify potential victims of violence and connect them with the appropriate resources before they got discharged."

Carter-Snell says the nurse became the department's expert on dealing with police, preserving evidence and documenting injuries.

The nurse's experience ultimately led to the creation of a new domestic violence coordinator position. The nurse herself was the successful candidate.

"Other ER nurses who have taken our forensic courses have then gone on to medical missions to work with sexually assaulted women in war ravaged regions, to work with women's shelters and to work with abused children," says Carter-Snell.

Training Required for Nursing Specialties

Becoming a registered nurse (RN) is the first step on the career path to a nursing specialty. Continuing education is very important for nurses. When Eyre shifted his career from nursing in a psychiatric hospital to intensive care and emergency nursing, he had to get additional training. He studied critical care and ICU nursing once a week for a year. He took additional emergency nursing courses, but a lot of the training overlapped with his ICU courses.

Pasqualone has been in nursing more than 40 years. She gained experience in intensive care and emergency department nursing. She discovered forensic nursing and found it applicable to what she was doing as an emergency nurse. Patients in emergency can sue somebody for the harm or injury that landed them in the hospital.

She discovered a master's program in forensic science and took the crime scene investigation track. Later she earned a second master's degree in forensic nursing, a program that she helped develop.

She tells aspiring nurses to never stop learning. In high school, she recommends concentrating heavily on the sciences and taking the education seriously. She also stresses the importance of being able to write well.

Inside the ER

As a forensic nurse, Carter-Snell gets called in to the emergency department to deal with patients. She works primarily as a sexual assault nurse examiner, which often involves victims of domestic violence. Working in this specialty, she can give her patients the time they need to make their care choices.

"This is truly client-centered care, which I learned much about but had difficulty implementing in a busy emergency department with chaotic and unpredictable demands and more than one client at a time," she says. Her team of forensic nurses responds to calls within 30 to 60 minutes. They spend two to three hours with each patient.

Carter-Snell recommends a minimum of two to three years of clinical experience before entering the forensic nursing specialty. Nurses should gain experience in an area requiring solid assessment skills and rapid decision making, ideally with trauma patients.

"Emergency and intensive care are invaluable for this," says Carter-Snell.

Emerging Emotions

Some nurses choose to specialize as sexual assault nurse examiners and do the job exclusively for 40 hours per week. Pasqualone did this for a while, but she couldn't do it exclusively for too long. "It's an emotional strain," she says. "My heart was being torn apart."

She says working in emergency suited her better. That was until she went out on her own as a forensic nurse consultant. Now she's hired as an expert in medical malpractice lawsuits. She also does work in crime scene reconstruction and teaches nurses at the graduate level. It was her experience in emergency nursing that opened these exciting doors for her in her career.

"After gaining that experience in the ER, flaunt it!" she says.

Eyre says a nurse's personality will play a big part in the specialty they choose. "We see a lot of blood and guts in emergency," he says. He's been nursing for over 30 years and finds his career very rewarding. However, he says nurses have to be able to put up a wall against their emotions in order to do a good job.

"It's not for everybody. But if you're a giving, caring person there's something in the medical field for you."

Learn more about emergency nursing

Journal of Emergency Nursing
Discover resources and information about emergency nursing

Emergency Nurses Association
Learn about this national association for emergency nurses

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